Wild Earth Wellness

LBN: Wild Earth Wellness
Wild Earth Wellness is an health care organization with primary practice located at 24850 Se Stark St Ste 200 , Gresham OR 97030-8320. The organization recently has only one registered license in Ambulatory Health Care Facilities / Health Service, which is considered as the primary health care specialty. Wild Earth Wellness can be contacted via phone (503) 310-2622, or through Boom, Jennifer Marie via phone (503) 310-2622.

Contact Information

Primary practice address
24850 Se Stark St Ste 200 Gresham OR 97030-8320
Phone: (503) 310-2622
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Boom, Jennifer Marie LMT
Phone: (503) 310-2622

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Health Service 261QH0100X 7615 Oregon

Profile Details

NPI number 1285159251
LBN Legal business name Wild Earth Wellness
DBA Doing business as
Authorized official Boom, Jennifer Marie LMT
Entity Organization
Organization subpart 1 No
Enumeration date Aug 10th, 2017
Last updated Jul 21st, 2022 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285159251 NPPES
Other 1164547634 NPI

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